View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
General Population Screener and Consent Process (Youth and Parent)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Parent Guardian Tablet Screener ExPECTT
Attachment 3_E2a. Parent Guardian Tablet Screener ExPECTT.docx
Yes
Yes
Fillable Fileable
Other-Parent Guardian Mail Screener A ExPECTT
Attachment 3_E2b1. Parent Guardian Mail Screener A ExPECTT.docx
No
Paper Only
Other-Parent Mail_Screener (male rural smokeless)
Attachment 3a_Parent Mail_Screener (male rural smokeless) 0910-0753.docx
No
Paper Only
Other-Parent Permission ExPECTT
Attachment 6_E1b. Parent Permission ExPECTT.doc
No
Paper Only
Other- Parent Permission ExPECTT (2)
Attachment 6_E2b1. Parent Permission ExPECTT Baseline.docx
No
Paper Only
Other-Parent Permission (male rural smokeless)
Attachment 06_R1. Parent Permission Forms (male rural smokeless) FU4.docx
No
Printable Only
Other-Parent Permission ExPECTT FU
Attachment 6_E2b2. Parent Permission ExPECTT_FU.docx
Yes
Yes
Fillable Fileable Signable
Other-Parent Guardian Mail Screener B ExPECTT
Attachment 3_E2b2. Parent Guardian Mail Screener B ExPECTT.docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30,880
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
30,880
0
0
0
0
30,880
Annual IC Time Burden (Hours)
5,250
0
0
0
0
5,250
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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